The Office of the Medicaid Inspector General (OMIG) Posts 2014 Compliance Program Certification Information and Forms

It’s that time of year again when Medicaid providers who are required to have an effective Medicaid Compliance Plan have to so certify to the OMIG. The on-line certification can only be done during the month of December. 2014 Compliance Program Certification information and forms for the December 2014 certification period are now posted on […]

The Federal Government Adds an Additional $23 Million to New York State’s Medicaid Bill

As far as the Federal government is concerned, it appears that New York is running up quite a bill in claimed overpayments to its Medicaid program.  After finding the State liable for nearly $1.26 billion in overpayments related to intermediate care facilities operated by the Office for People with Developmental Disabilities (“OPWDD”), the United States […]

CMS Issues 2015 Managed Care Rate Setting Consultation Guide

On Wednesday, October 2, the Centers for Medicare and Medicaid Services (“CMS”) issued its  2015 consultation guide for states to use when setting reimbursement rates with respect to any Medicaid managed care program subject to actuarial soundness requirements in 42 CFR 438.6 during rating periods starting January 1, 2015.  The guide “describes information that CMS expects states to provide […]

Who’s Looking Out for Patients? OIG Recommends more CMS Oversight of Medicaid Managed Care Programs

Office of the Inspector General of the federal Department of Health and Human Services (“OIG”) has issued a report that suggests that most states that offer Medicaid through Managed Care Organizations (“MCOs”) have widely-variable and possibly inadequate oversight of the organizations providing care to Medicaid beneficiaries.  Given OIG’s findings, beneficiaries, providers, and Medicaid MCOs should […]

NYC HRA Sued under False Claims Act by Whistleblower; Settles with US DOJ for $1.05 Million

According to United States Attorney Richard S. Hartunian, the City of New York (NYC) has agreed to pay the United States Department of Justice (US DOJ) $1.05 million to settle allegations that the NYC Human Resources Administration (HRA) violated the federal False Claims Act by causing various managed care organizations (MCOs) to provide Medicaid coverage […]

Auditing the Auditors: OSC Audits the OMIG and Questions the Accuracy of OMIG’s Cost Saving Figures

The New York State Office of the State Controller (“OSC”) has released its audit of the New York State Office of the Medicaid Inspector General (“OMIG”) entitled “Accuracy of Reported Cost Savings.” The final report, issued July 11th, presented OSC’s findings regarding the accuracy of the OMIG’s reported cost savings for calendar years 2008 through […]

Attention OMH Continuing Day Treatment Providers: OIG Releases Audit of CDT Programs, Seeks Repayment of over $18 Million to Federal Medicaid Program

The United States Department of Health and Human Services Office of the Inspector General (“OIG”) conducted an audit of New York State’s nonhospital-based Continuing Day Treatment (“CDT”) program.   CDT services are clinic services administered by the New York State Office of Mental Health (“OMH”). OMH’s CDT program provides Medicaid recipients with treatment designed to […]

Attention Medicaid and Medicare Providers: US DOJ Sues Providers for Failing to Return Overpayments Within 60 Days

On June 27, 2014, in the case of United States ex rel. Kane v. Healthfirst, Inc., et al., No. 11-2325 (S.D.N.Y.), the United States Department of Justice (USDOJ), via the United States Attorney’s Office for the Southern District of New York, sued several Medicaid providers under the federal False Claims Act for failing to return […]

Office of the Medicaid Inspector General Releases 2014-2015 Work Plan

The New York State Office of the Medicaid Inspector General (“OMIG) has released its State Fiscal Year 2014-2015 Work Plan. You can find the press release at: http://www.omig.ny.gov/latest-news/764-2014-15-work-plan The Work Plan is a road map of where the OMIG intends to go in terms of its anti fraud, waste and abuse efforts within the Medicaid […]